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S1459.......................................by COMMERCE AND HUMAN RESOURCES
HOSPITAL-BASED REHABILITATION - Amends existing law to include
hospital-based rehabilitation treatment in the definition of basic health
care services under the law regarding managed care.
02/13 Senate intro - 1st rdg - to printing
02/16 Rpt prt - to Com/HuRes
02/20 Rpt out - rec d/p - to 2nd rdg
02/23 2nd rdg - to 3rd rdg
02/26 3rd rdg - PASSED - 35-0-0
AYES -- Andreason, Boatright, Branch, Bunderson, Burtenshaw, Cameron,
Crow, Danielson, Darrington, Diede, Dunklin, Frasure, Geddes, Hansen,
Hawkins, Ingram, Ipsen, Keough, King, Lee, McLaughlin, Noh, Parry,
Richardson, Riggs, Risch, Sandy, Schroeder, Sorensen, Stennett,
Sweeney, Thorne, Twiggs, Wheeler, Whitworth
NAYS -- None
Absent and excused -- None
Floor Sponsor - King
Title apvd - to House
02/27 House intro - 1st rdg - to Bus
03/12 Rpt out - rec d/p - to 2nd rdg
03/13 2nd rdg - to 3rd rdg
03/16 3rd rdg - PASSED - 70-0-0
AYES -- Alltus, Barraclough, Barrett, Bell, Bieter, Bivens,
Black(15), Black(23), Boe, Bruneel, Callister, Campbell, Chase,
Clark, Crane, Crow, Cuddy, Deal, Denney, Ellsworth, Field(13),
Field(20), Gagner, Geddes, Gould, Hadley, Hansen, Henbest, Hornbeck,
Jaquet, Jones(9) Jones(22), Jones(20), Judd, Kellogg, Kempton,
Kendell, Kjellander, Kunz, Lake, Linford, Loertscher, Mader, Marley,
McKague, Meyer, Miller, Mortensen, Newcomb, Pischner, Pomeroy,
Reynolds, Richman, Ridinger, Robison, Sali, Schaefer, Stevenson,
Stoicheff, Stone, Stubbs, Taylor, Tilman, Tippets, Trail, Watson,
Wheeler, Wood, Zimmermann, Mr. Speaker.
NAYS -- None
Absent and excused -- None
Floor Sponsor - Deal
Title apvd - to Senate
03/16 To enrol
03/18 Rpt enrol - Pres signed
Sp signed
03/19 To Governor
03/20 Governor signed
Session Law Chapter 142
Effective: 07/01/98
S1459|||| LEGISLATURE OF THE STATE OF IDAHO |||| Fifty-fourth Legislature Second Regular Session - 1998IN THE SENATE SENATE BILL NO. 1459 BY COMMERCE AND HUMAN RESOURCES COMMITTEE 1 AN ACT 2 RELATING TO HEALTH MAINTENANCE ORGANIZATIONS; AMENDING SECTION 41-3903, IDAHO 3 CODE, TO INCLUDE HOSPITAL-BASED REHABILITATION TREATMENT IN THE DEFINITION 4 OF BASIC HEALTH CARE SERVICES. 5 Be It Enacted by the Legislature of the State of Idaho: 6 SECTION 1. That Section 41-3903, Idaho Code, be, and the same is hereby 7 amended to read as follows: 8 41-3903. DEFINITIONS. (1) "Basic health care services" means the follow- 9 ing services: preventive care, emergency care, inpatient and outpatient hospi- 10 tal and physician care, hospital-based rehabilitation treatment, 11 diagnostic laboratory and diagnostic and therapeutic radiological services. 12 It does not include mental health services or services for alcohol or drug 13 abuse, dental or vision services or long-term rehabilitation treatment. 14 (2) "Coinsurance" means a percentage amount a member is responsible to 15 pay out-of-pocket for health care services after satisfaction of any applica- 16 ble deductibles or copayments, or both. 17 (3) "Copayment" means an amount a member must pay to a provider in pay- 18 ment for a specific health care service which is not fully prepaid. 19 (4) "Deductible" means the amount of expense a member must first incur 20 before the managed care organization begins payment for covered services. 21 (5) "Director" means the director of the department of insurance of the 22 state of Idaho. 23 (6) "Emergency facility" means any hospital or other facility where emer- 24 gency services are provided to a member including, but not limited to, a 25 physician's office. 26 (7) "Emergency services" means those health care services that are pro- 27 vided in a hospital or other emergency facility after the sudden onset of a 28 medical condition that manifests itself by symptoms of sufficient severity 29 including, but not limited to, severe pain, that the absence of immediate med- 30 ical attention could reasonably be expected by a prudent person who possesses 31 an average knowledge of health and medicine, to result in: 32 (a) Placing the patient's health in serious jeopardy; 33 (b) Serious impairment to bodily functions; or 34 (c) Serious dysfunction of any bodily organ or part. 35 (8) "Employer" means any person, firm, corporation, partnership or asso- 36 ciation. 37 (9) "Enrollee" means a person who either individually or through a group 38 has entered into a contract for services under a managed care plan. 39 (10) "General managed care plan" means a managed care plan which provides 40 directly or arranges to provide, at a minimum, basic health care services. A 41 general managed care plan shall include basic health care services. 42 (11) "Health care contract" means a contract entered into by a managed 43 care organization and an enrollee. 2 1 (12) "Health care services" means those services offered or provided by 2 health care facilities and health care providers relating to the prevention, 3 cure or treatment of illness, injury or disease. 4 (13) "Limited managed care plan" means a managed care plan which provides 5 dental care services, vision care services, mental health services, substance 6 abuse services, pharmaceutical services, podiatric care services or such 7 other services as the director may establish by rule to be limited health care 8 services. Limited health care services shall not include hospital, medical, 9 surgical or emergency services except as those services are provided incident 10 to limited health care services. 11 (14) "Managed care organization" means a public or private person or orga- 12 nization which offers a managed care plan. Unless otherwise specifically 13 stated, the provisions of this chapter shall apply to any person or organiza- 14 tion offering a managed care plan, whether or not a certificate of authority 15 to offer the plan is required under this chapter. 16 (15) "Managed care plan" means a contract of coverage given to an individ- 17 ual, family or group of covered individuals pursuant to which a member is 18 entitled to receive a defined set of health care benefits through an organized 19 system of health care providers in exchange for defined consideration and 20 which requires the member to use, or creates financial incentives for the mem- 21 ber to use, health care providers owned, managed, employed by or under con- 22 tract with the managed care organization. 23 (16) "Member" means a policyholder, enrollee or other individual partici- 24 pating in a managed care plan. 25 (17) "Person" means any natural or artificial person including, but not 26 limited to, individuals, partnerships, associations, corporations or other 27 legally recognized entities. 28 (18) "Provider" means any physician, hospital, or other person licensed or 29 otherwise authorized to furnish health care services. 30 (19) "Utilization management program" means a system of reviewing the med- 31 ical necessity, appropriateness, or quality of health care services and sup- 32 plies provided under a managed care plan using specified guidelines. Such a 33 system may include, but is not limited to, preadmission certification, the 34 application of practice guidelines, continued stay review, discharge planning, 35 preauthorization of ambulatory procedures and retrospective review.
STATEMENT OF PURPOSE/FISCAL NOTE
RS 08027
The purpose of this legislation is to clarify the definition of "basic health care services" in the
managed care reform act passed by the legislature last year. By adding the four words
"hospital based rehabilitation treatment" to the definition, it is clear that the intent of the
language was not to exclude acute rehabilitation services as services considered basic
health care services. Hospital based rehabilitation is a basic health care service as
contemplated in the statute. It is an adjunct to almost all acute inpatient and outpatient care.
The second sentence of the definition appropriately excludes longterm rehabilitation
treatment. This additional language is intended to contrast and be a clarification to this
exclusion.
FISCAL NOTE
There will be no fiscal impact on the state general fund nor on any local taxing entity.
Contact:
Name: Steven A. Millard
Organization: Idaho Hospital
Association
Telephone: (208) 338-5100,
ext. 203
S 1459